Treatment, not jail, for addicts, mentally ill

Op-ed: Treatment keeps addicts out of jail, so why don't we offer it?

As I sat with a client I'll call Grace in Baltimore County District Court in Essex, I watched case after case go before the judge. It was mostly less serious crimes: theft, possession of paraphernalia, driving without a license and trespassing. But all the cases, except for most of the traffic cases, had elements of mental illness and addiction, like the mother who was experiencing homelessness and hadn't been getting her children to school on a regular basis. She had prior arrests of possession of a controlled dangerous substance and theft.

Grace, too, had been homeless and using heroin for years, after watching her mother do the same thing her whole life. Her mother sadly passed away late last winter from an overdose. After her mother's death Grace said she lost all hope. "It was a death sentence for me." Grace was arrested in August of this year for credit card theft.

I have been a social work intern at the Maryland Office of the Public Defender for three months. During this time, I have not been assigned a case that does not involve alcohol, prescription or illicit drugs, or mental illness. Sometimes it is only one of these, but most times it is a combination of all three. The majority of the clients have committed non-violent crimes. The Bureau of Justice Statistics has estimated that 1.2 million people with mental illness are incarcerated at the local, state or federal level. The National Center on Addiction and Substance Abuse at Columbia University reports that of the more than 2.3 million people in American prisons and jails, more than 65 percent meet medical criteria for substance abuse addiction. When you combine this with those who have histories of substance abuse, were under the influence when they committed a crime, committed it to get drug money, or were incarcerated for a drug or alcohol violation, this rises to 85 percent. That is over 50 percent of incarcerated people with mental health issues and 85 percent with past or present substance abuse issues. Only about 11 percent of these people receive treatment for their diseases.

These numbers don't lie. We are locking up people suffering from mental illness and addiction, and then not treating them. The result: They have a much greater chance of repeating their past mistakes, jails are overcrowded, and the national economy suffers.

Those of us living in the Baltimore area know that there is a prescription opioid and heroin epidemic that is killing people in unprecedented numbers. Heroin deaths in the city have surpassed deaths from motor vehicle accidents and homicides. But it of course doesn't stop at the city line. Opioid addiction and overdose death has risen at a frightening rate all across the state and all across the country. Data from the Centers for Disease Control and Prevention show that from 2001 through 2013 deaths from prescription opioid medications rose threefold, and deaths from heroin overdose rose fivefold. Close to 44,000 people died in 2013 from opioid drug overdoses. The Substance Abuse and Mental Health Services Administration estimates that 4 million people in the United State are dual-diagnosed with mental illness and drug/alcohol addiction.

I spoke to the court on behalf of Grace. She readily admitted she has a serious drug problem and that she needed help with her addiction and mental health issues. In late October she had entered Powell Recovery on South Broadway and was almost six weeks clean that day in court. The judge heard our case, and he shook his head. "I don't know what to do here. I really don't." He adjourned her case while he thought it over and heard other cases. There we sat, sweating it out, until the judge recalled her case over an hour later. He gave her an 18-month sentence — suspended — and mandated that she complete the six-month program at Powell.

Grace won in court that day, but hundreds of thousands of others don't get the chance she got. It's past time to treat, rather than incarcerate, people suffering from mental illness and addiction. It's a cheaper and more effective approach, and it treats a vulnerable population with the dignity they deserve.

The National Association of Drug Court Professionals reports that 75 percent of people who complete a drug court program never see another set of handcuffs again. Of those who do not complete a treatment program, 73 percent return to prison within three years.

Unfortunately Grace relapsed — as so many recovering addicts do on their way to sobriety — and never got to complete the program at Powell; she died from a heroin overdose four days before Christmas. Her death is a reminder that recovery is difficult under any circumstances, but without treatment, it's almost impossible.

Alexander Persons is a social work intern at the Maryland Office of the Public Defender; his email is

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